Expensive medication, from those used in chronic diseases to complex treatments, can be obtained free of charge through the SUS by a specific route: the Specialized Component of Pharmaceutical Care, known as “high-cost” medication. It is not the UBS pharmacy nor the Farmácia Popular: it is a process of its own, with one central document and clear rules. Knowing the steps saves months of back-and-forth. This guide describes it.
The central document: the LME
The heart of the request is the LME, the form for requesting, assessing and authorizing medication. It is filled in by the doctor, justifying why you need that specific drug. A well-completed LME, with the correct diagnosis (ICD code), clinical description and dosage, is what moves the request forward; an incomplete LME is the most common reason for rejection.
What to gather
- Photo ID, CPF and SUS Card;
- proof of address;
- a valid prescription;
- the LME completed and signed by the doctor;
- the exams and reports required by that drug’s protocol.
Where to file it
The request is not filed at the UBS: it goes to the Specialized Component pharmacy, usually linked to the State Health Department. Confirm at your UBS or state department where your region’s filing point is, and keep the dated receipt of delivery.
The deciding criterion: the PCDT
Each drug in the program is tied to a Clinical Protocol and Therapeutic Guideline (PCDT), which defines for which diagnosis and under what criteria it is provided. If your case fits the protocol, provision is the rule. Difficulty appears in two situations: when the drug is not on the SUS list, and when, even though it is, the request is denied on formal grounds.
If it is denied or not on the list
- Ask for the denial in writing, with the reason. Many refusals are formal (a missing document, an incomplete LME) and are solved by correcting the request.
- Contact the SUS Ombudsman (136) and the health department for guidance and a record.
- If the drug is not on the SUS list but is essential, with a well-founded prescription and no available therapeutic alternative, there is a judicial route.
This guide is part of our practical series on how to use the SUS.
About the author
Ramon Martins Andrade (OAB/RJ 188.374) is a lawyer graduated from UFRJ in 2011, holding master’s degrees from the Université Sorbonne Nouvelle and from the Brazilian Naval War College (EGN). He is currently a researcher in Human Rights and Health at ENSP/Fiocruz, where the concept of sanitary return emerged from his research in study groups on the Brazilian diaspora and access to healthcare.
This content is for informational and educational purposes only. It does not constitute legal advice, advertising of results, or any guarantee of outcome, under Rule (Provimento) 205/2021 of the Brazilian Bar Association (OAB).